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    Physical activity decreases inflammation linked to psoriatic arthritis

    Exercise represents strategy to manage chronic pain


    With the expansion in recent years of prescription opioids for patients who have chronic non-cancer pain, and with the associated risk of addiction, it is imperative to find other strategies to manage chronic non-cancer pain. While Dr. Pereira says opioids can have a role in pain management, it is critical to evaluate if patients are at high risk of addiction to opioids.

    "The key is assessing patients carefully and making sure that alternative treatments have been considered," says Dr. Pereira. "We have useful screening tools to help identify which patients are more likely to develop aberrant drug behaviors.

    "You can reach a point of diminishing returns with these medications," says Dr. Pereira. "Many patients are interested in natural approaches to pain management."

    Natural approaches to control inflammation include carefully graded exercise and dietary modifications such as eating more fish high in omega-3 fats, according to Dr. Pereira.

    Vinod Chandran, MD, PhD, Assistant Professor of Medicine, Division of Rheumatology, University of Toronto, Staff Physician, Division of Rheumatology, University Health Network, suggests that dermatologists routinely enquire if their patients with psoriasis have sensations of pain, particularly joint pain.

    "Patients (with psoriasis) may see a dermatologist and not mention that they are also having pain," says Dr. Chandran, a member of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis. "Dermatologists should ask if patients have joint pain or swelling and back pain. If they say that they do, they should be sent to a rheumatologist."

    If patients continue to go undiagnosed with arthritis, by the time they undergo x-rays, their arthritis may be quite advanced, stresses Dr. Chandran. "There needs to be early diagnosis of psoriatic arthritis," says Dr. Chandran.

    Ideally, clinics should feature both dermatologists and rheumatologists to optimize management of psoriasis and psoriatic arthritis, says Dr. Chandran. Failing an actual clinic, these specialists should be in virtual contact, which would expedite referral of patients from a dermatologist to a rheumatologist or the reverse, puts forth Dr. Chandran.

    "If there is inflammatory pain, there needs to be management of the inflammation," says Dr. Chandran. "Even when patients are taking a biologic (therapy) to treat their psoriatic arthritis, it is important they maintain activity like stretching and yoga to maintain their mobility."

    Patient with psoriasis and psoriatic arthritis have a high prevalence of metabolic co-morbidities, including obesity. These co-morbidities will improve if patients with psoriatic arthritis exercise regularly. If patients have depression, activity will likely improve their mood, says Dr. Chandran. "Depression is very common in these patients," he notes, adding many patients with psoriatic arthritis are in the prime of their life. "If you are more physically active, you are in a better mental state."

    Next: Managing pain


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